Surprise medical bills receive federal attention

Conor Laing
Assistant Policy Analyst

Friday, February 19th, 2016

In August of 2014, Danny Postell’s son received care in an Intensive Care Unit (ICU) at a Georgia hospital.  The hospital and almost all of the physicians involved were in Danny’s insurance network, but the ICU pediatrician  who oversaw his son’s intensive care was out-of-network.  The Postells were unaware he was out-of-network, not least because their son was on their mind.  Danny and his family received a surprise medical bill of almost $2,500 from this out-of-network doctor.

When you buy health insurance, it should cover you when you need it.  But as Danny Postell’s story shows us, too often consumers who have done nothing wrong get hit with surprise out-of-network medical bills.   We have heard from thousands of you who have received more than $8.9 million in surprise medical bills.  A 2015 national survey conducted by Consumer Reports found among respondents who received a surprise bill, nearly one of four got a bill from a doctor they did not expect to get a bill from. And the majority of all respondents nationally assume that doctors at an in-network hospital are also in the plan’s network.

Surprise out-of-network medical bills have become such a problem for consumers that they are now receiving attention from the President of the United States.  President Obama’s budget for 2017 includes a provision to end surprise out-of-network medical bills.  We applaud the President’s attention to surprise bills and believe Congress should take action as  many states from New York to Connecticut have done or (as Florida, Washington, Pennsylvania, and Georgia) are in the process of doing  to protect all consumers from surprise out-of-network medical bills.

That is why Consumers Union supports the End Surprise Billing Act of 2015. This bill would protect consumers from surprise out-of-network bills when they make a good faith effort to get in-network care.  This bill requires that consumers receive advance notice that a provider will be out-of-network before a procedure.  In situations where this would be impossible, like emergency medical situations, consumers would only be on the hook for what they would pay for an in-network procedure.

There are a number of things you can do to stand up to these unfair bills. Contact your Members of Congress and ask them to cosponsor the End Surprise Billing Act. A handful of states are working to pass laws protecting consumers from these unfair surprise bills. Check out our map to find out if your state is proposing legislation, and how you can get involved. You should have the peace of mind that your insurance will actually be useful when receiving healthcare.

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